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1.
Lancet Psychiatry ; 8(12): 1019-1021, 2021 12.
Article in English | MEDLINE | ID: covidwho-1521656
2.
JAMA Netw Open ; 4(11): e2134803, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1516698

ABSTRACT

Importance: Infection with SARS-CoV-2 is associated with fatigue and sleep problems long after the acute phase of COVID-19. In addition, there are concerns of SARS-CoV-2 infection causing psychiatric illness; however, evidence of a direct effect is inconclusive. Objective: To assess risk of risk of incident or repeat psychiatric illness, fatigue, or sleep problems following SARS-CoV-2 infection and to analyze changes according to demographic subgroups. Design, Setting, and Participants: This cohort study assembled matched cohorts using the Clinical Practice Research Datalink Aurum, a UK primary care registry of 11 923 499 individuals aged 16 years or older. Patients were followed-up for up to 10 months, from February 1 to December 9, 2020. Individuals with less than 2 years of historical data or less than 1 week follow-up were excluded. Individuals with positive results on a SARS-CoV-2 test without prior mental illness or with anxiety or depression, psychosis, fatigue, or sleep problems were matched with up to 4 controls based on sex, general practice, and year of birth. Controls were individuals who had negative SARS-CoV-2 test results. Data were analyzed from January to July 2021. Exposure: SARS-CoV-2 infection, determined via polymerase chain reaction testing. Main Outcomes and Measures: Cox proportional hazard models estimated the association between a positive SARS-CoV-2 test result and subsequent psychiatric morbidity (depression, anxiety, psychosis, or self-harm), sleep problems, fatigue, or psychotropic prescribing. Models adjusted for comorbidities, ethnicity, smoking, and body mass index. Results: Of 11 923 105 eligible individuals (6 011 020 [50.4%] women and 5 912 085 [49.6%] men; median [IQR] age, 44 [30-61] years), 232 780 individuals (2.0%) had positive result on a SARS-CoV-2 test. After applying selection criteria, 86 922 individuals were in the matched cohort without prior mental illness, 19 020 individuals had prior anxiety or depression, 1036 individuals had psychosis, 4152 individuals had fatigue, and 4539 individuals had sleep problems. After adjusting for observed confounders, there was an association between positive SARS-CoV-2 test results and psychiatric morbidity (adjusted hazard ratio [aHR], 1.83; 95% CI, 1.66-2.02), fatigue (aHR, 5.98; 95% CI, 5.33-6.71), and sleep problems (aHR, 3.16; 95% CI, 2.64-3.78). However, there was a similar risk of incident psychiatric morbidity for those with a negative SARS-CoV-2 test results (aHR, 1.71; 95% CI, 1.65-1.77) and a larger increase associated with influenza (aHR, 2.98; 95% CI, 1.55-5.75). Conclusions and Relevance: In this cohort study of individuals registered at an English primary care practice during the pandemic, there was consistent evidence that SARS-CoV-2 infection was associated with increased risk of fatigue and sleep problems. However, the results from the negative control analysis suggest that unobserved confounding may be responsible for at least some of the positive association between COVID-19 and psychiatric morbidity.


Subject(s)
COVID-19/complications , Fatigue/etiology , Pandemics , Psychological Distress , Psychotropic Drugs/therapeutic use , Sleep Wake Disorders/etiology , Sleep , Adult , Anxiety/drug therapy , Anxiety/epidemiology , Anxiety/etiology , COVID-19/psychology , COVID-19/virology , Cohort Studies , Depression/drug therapy , Depression/epidemiology , Depression/etiology , England/epidemiology , Fatigue/epidemiology , Female , Humans , Male , Middle Aged , Prevalence , Primary Health Care , Psychotic Disorders/drug therapy , Psychotic Disorders/epidemiology , Psychotic Disorders/etiology , Risk Factors , SARS-CoV-2 , Sleep Wake Disorders/epidemiology , Stress, Psychological/etiology
4.
Assay Drug Dev Technol ; 19(6): 373-385, 2021.
Article in English | MEDLINE | ID: covidwho-1349762

ABSTRACT

Recent reports have highlighted the possible role of the antipsychotic chlorpromazine and the antidepressant fluvoxamine as anti-coronavirus disease 2019 (COVID-19) agents. The objective of this narrative review is to explore what is known about the activity of psychotropic medications against viruses in addition to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). PubMed was queried for "drug repurposing, antiviral activity," and for "antiviral activity" with "psychotropic drugs" and individual agents, through November 2020. Of more than 100 psychotropic agents, 37 drugs, including 27 with a history of pediatric use were identified, which had been studied in the preclinical setting and found to have activity against viruses which are human pathogens. Effects were evaluated by type of virus and by category of psychotropic agent. Activity was identified both against viruses known to cause epidemics such as SARS-CoV-2 and Ebola and against those that are the cause of rare disorders such as Human Papillomatosis Virus-related respiratory papillomatosis. Individual drugs and classes of psychotropics often had activity against multiple viruses, with promiscuity explained by shared viral or cellular targets. Safety profiles of psychotropics may be more tolerable in this context than when they are used long-term in the setting of psychiatric illness. Nonetheless, translation of in vitro results to the clinical arena has been slow. Psychotropic medications as a class deserve further study, including in clinical trials for repurposing as antiviral drugs for children and adults.


Subject(s)
Antiviral Agents/therapeutic use , COVID-19/drug therapy , Drug Repositioning/methods , Psychotropic Drugs/therapeutic use , COVID-19/immunology , COVID-19/metabolism , Drug Repositioning/trends , Humans
5.
Health Aff (Millwood) ; 40(6): 904-909, 2021 06.
Article in English | MEDLINE | ID: covidwho-1280643

ABSTRACT

COVID-19 interrupted delivery of mental health care in the US. During the initial course of the COVID-19 pandemic new starts of antidepressants declined by 7.5 percent, anxiolytics by 5.6 percent, and antipsychotics by 2.6 percent compared with expected levels. Our findings suggest that there is large unmet need for mental health treatment in the US due to COVID-19.


Subject(s)
Antipsychotic Agents , COVID-19 , Mental Disorders , Antipsychotic Agents/therapeutic use , Humans , Mental Disorders/drug therapy , Mental Disorders/epidemiology , Pandemics , Psychotropic Drugs/therapeutic use , SARS-CoV-2
6.
PLoS One ; 16(5): e0251525, 2021.
Article in English | MEDLINE | ID: covidwho-1232463

ABSTRACT

INTRODUCTION: SARS-Cov-2 virus pandemic causes serious emotional consequences. It has occurred widespread medical courses suspension, and graduations were anticipated. Field hospitals, set up to treat patients with mild to moderate COVID-19, were the main workplaces of newly graduated doctors. OBJECTIVE: To assess the impact of SARS-Cov-2/COVID-19 pandemic on mental health of medical interns and newly graduated doctors. METHOD: This is a cross-sectional study performed using a digital platform. Links to forms were sent in two moments: moment 1 (M1), at the beginning of the pandemic, in the first half of April/2020 and moment 2 (M2), after six months of pandemic, in the second half of September/2020. All students from the medical internship and all doctors graduated since 2018 from the three medical schools in Sergipe-NE-Brazil were invited. RESULTS: 335 forms were answered in April and 148 in September. In M1 88.9% considered themselves exposed to excess of information about COVID-19, which was associated with anxiety symptoms (p = 0.04). Long family physical distance was also associated with these symptoms, as increased appetite (p = 0.01), feeling shortness of breath (p = 0.003) and sweating (p = 0.007). Fear of acquire COVID-19 was reported as intense by almost half of participants, and of transmitting by 85.7% in M1. In M2 41.2% reported the death of friends or relatives. Psychiatric illness was described by 38.5% and psychotropic drugs use by 30.1% in M1, especially those who lived alone (p = 0.03) and the single ones (p = 0.01). Alcohol intake was reported by 54.3%, and among doctors graduated in 2020 it increased from 50% in M1 to 85% in M2 (p = 0.04). CONCLUSION: The pandemic had a negative impact on the mental health of medical students and newly graduated doctors. Exposure to excessive COVID-19 information and family physical distance were associated to anxiety symptoms. Among doctors graduated in 2020, alcohol intake increased during pandemic evolution.


Subject(s)
Anxiety/pathology , COVID-19/epidemiology , Mental Health , Physicians/psychology , Students, Medical/psychology , Adult , Alcohol Drinking , Anxiety/drug therapy , Brazil/epidemiology , COVID-19/pathology , COVID-19/virology , Cross-Sectional Studies , Female , Humans , Internship and Residency , Male , Pandemics , Psychotropic Drugs/therapeutic use , SARS-CoV-2/isolation & purification , Young Adult
7.
Int J Psychiatry Clin Pract ; 25(2): 142-146, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1221414

ABSTRACT

OBJECTIVE: Psychiatric patients are at increased risk of contamination, morbidity, and mortality associated with COVID-19, together with potentially more pronounced adverse effects. We present and discuss the adverse effects observed in an acute psychiatric clinic that has admitted COVID-19 patients during the first three months of the pandemic in Turkey. METHODS: The COVID-19 treatment schemes were formed in accordance with the national and regional guidelines at the time of admittance, which were mainly based on the use of hydroxychloroquine and other drugs. The sample consisted exclusively of inpatients, and all patients were enrolled in the study regardless of their specific diagnosis or treatment schemes. RESULTS: 4 out of 23 patients (17.4%) had experienced adverse effects, two of which had mild hepatic enzyme elevation and one had mild sinus bradycardia. Of note is that we haven't encountered any serious complications or life-threatening events during inpatient treatment. The most emphasised adverse effect in the literature, namely QTc prolongation and ECG changes, were not observed in our sample. The adverse effects were not found to be significantly associated with patient-related factors nor dose of antipsychotic medication. CONCLUSIONS: From our point of view, non-cardiac adverse effects should not be overlooked while treating comorbid psychiatric and COVID-19 patients.KEY POINTSAcute inpatient psychiatric treatment of patients who have comorbid COVID-19 is a complex situation requiring multidisciplinary action.Adverse drug reactions, which may or not result from the interaction of psychiatric and COVID-19 treatment, should be of concern for this patient group.While there is controversy over the benefits of some of the off-label COVID-19 medications, there should also be discussion over safety and concomitant medication use.In order to be adequately prepared for future escalations of COVID-19 pandemic, psychiatric services should thoroughly evaluate their initial experience with COVID-19, including from the point of drug effectiveness and safety.


Subject(s)
Antiviral Agents/adverse effects , COVID-19/drug therapy , Drug-Related Side Effects and Adverse Reactions/etiology , Mental Disorders/drug therapy , Psychotropic Drugs/adverse effects , Adult , Antiviral Agents/administration & dosage , Antiviral Agents/therapeutic use , COVID-19/complications , Drug Interactions , Drug-Related Side Effects and Adverse Reactions/epidemiology , Female , Hospitals, Psychiatric/statistics & numerical data , Humans , Male , Mental Disorders/complications , Middle Aged , Psychotropic Drugs/administration & dosage , Psychotropic Drugs/therapeutic use
9.
Hum Psychopharmacol ; 36(5): e2789, 2021 09.
Article in English | MEDLINE | ID: covidwho-1182144

ABSTRACT

INTRODUCTION: Inpatients with coronavirus disease 2019 (COVID-19) show a high rate of neuropsychiatric manifestations, possibly related to a higher risk of serious illness or death. Use of psychotropic medications (PMs) indicates the presence of neuropsychiatric symptoms in COVID-19 patients. So far, potential clinical predictors of use of PMs have not been much investigated. In order to extend research in this area, we aimed to investigate the prevalence of PM prescription among a sample of inpatients with COVID-19 and to find potential predictors of initiation of PMs in these individuals. METHODS: This is a cross-sectional single-center study, conducted during the first outbreak peak in a hospital of northern Italy. Information on socio-demographic characteristics, comorbidities, routine blood test, use of potential COVID-19 treatments, and length of stay were retrieved from medical records. RESULTS: Data were available for 151 inpatients. Forty-seven of them (31.1%) started at least one prescription of a PM. PM prescription was significantly inversely associated with lymphocyte and platelet counts. A significant association was also found for lactate dehydrogenase (LDH). CONCLUSION: Our findings suggest that the initiation of PMs could be common among COVID-19 inpatients. Lymphocyte and platelet counts as well as LDH levels may reflect neuropsychiatric complications of COVID-19.


Subject(s)
COVID-19/drug therapy , COVID-19/epidemiology , Hospitalization/trends , Psychotropic Drugs/therapeutic use , Aged , Aged, 80 and over , COVID-19/psychology , Cross-Sectional Studies , Female , Humans , Italy/epidemiology , Male , Mental Disorders/drug therapy , Mental Disorders/epidemiology , Mental Disorders/psychology , Middle Aged
10.
Acta Psychiatr Scand ; 143(6): 526-534, 2021 06.
Article in English | MEDLINE | ID: covidwho-1180758

ABSTRACT

OBJECTIVE: To determine how mental disorders and psychopharmacological treatments before and during COVID-19 hospital admissions are related to mortality. METHODS: Subjects included in the study were all adult patients with a diagnosis of COVID-19, confirmed clinically and by PCR, who were admitted to a tertiary university hospital in Badalona (Spain) between March 1 and November 17, 2020. Data were extracted anonymously from computerized clinical records. RESULTS: 2,150 subjects were included, 57% males, mean age 61 years. History of mental disorders was registered in 957 (45%). Throughout admission, de novo diagnosis of mood or anxiety, stress, or adjustment disorder was made in 12% of patients without previous history. Delirium was diagnosed in 10% of cases. 1011 patients (47%) received a psychotropic prescription during admission (36% benzodiazepines, 22% antidepressants, and 21% antipsychotics). Mortality rate was 17%. Delirium during admission and history of mood disorder were independently associated with higher mortality risk (hazard ratios, 1.39 and 1.52 respectively), while previous year's treatments with anxiolytics/hypnotics and antidepressants were independently associated with lower mortality risk (hazard ratios, 0.47 and 0.43, respectively). CONCLUSION: Mental symptoms are very common in patients hospitalized for COVID-19 infection. Detecting, diagnosing, and treating them is key to determining the prognosis of the disease and functional recovery.


Subject(s)
COVID-19 , Inpatients , Mental Disorders , Psychotropic Drugs , COVID-19/diagnosis , COVID-19/mortality , COVID-19/psychology , COVID-19/rehabilitation , COVID-19 Nucleic Acid Testing , Female , Hospital Records/statistics & numerical data , Hospitalization/statistics & numerical data , Humans , Inpatients/psychology , Inpatients/statistics & numerical data , Male , Mental Disorders/diagnosis , Mental Disorders/drug therapy , Mental Disorders/epidemiology , Mental Disorders/virology , Middle Aged , Prognosis , Psychotropic Drugs/classification , Psychotropic Drugs/therapeutic use , Recovery of Function , Risk Assessment , SARS-CoV-2/isolation & purification , Spain/epidemiology
12.
BMC Med ; 19(1): 51, 2021 02 22.
Article in English | MEDLINE | ID: covidwho-1094033

ABSTRACT

BACKGROUND: The objective of this study was to investigate the relation of severe COVID-19 to prior drug prescribing. METHODS: Severe cases were defined by entry to critical care or fatal outcome. For this matched case-control study (REACT-SCOT), all 4251 cases of severe COVID-19 in Scotland since the start of the epidemic were matched for age, sex and primary care practice to 36,738 controls from the population register. Records were linked to hospital discharges since June 2015 and dispensed prescriptions issued in primary care during the last 240 days. RESULTS: Severe COVID-19 was strongly associated with the number of non-cardiovascular drug classes dispensed. This association was strongest in those not resident in a care home, in whom the rate ratio (95% CI) associated with dispensing of 12 or more drug classes versus none was 10.8 (8.8, 13.3), and in those without any of the conditions designated as conferring increased risk of COVID-19. Of 17 drug classes postulated at the start of the epidemic to be "medications compromising COVID", all were associated with increased risk of severe COVID-19 and these associations were present in those without any of the designated risk conditions. The fraction of cases in the population attributable to exposure to these drug classes was 38%. The largest effect was for antipsychotic agents: rate ratio 4.18 (3.42, 5.11). Other drug classes with large effects included proton pump inhibitors (rate ratio 2.20 (1.72, 2.83) for = 2 defined daily doses/day), opioids (3.66 (2.68, 5.01) for = 50 mg morphine equivalent/day) and gabapentinoids. These associations persisted after adjusting for covariates and were stronger with recent than with non-recent exposure. CONCLUSIONS: Severe COVID-19 is associated with polypharmacy and with drugs that cause sedation, respiratory depression, or dyskinesia; have anticholinergic effects; or affect the gastrointestinal system. These associations are not easily explained by co-morbidity. Measures to reduce the burden of mortality and morbidity from COVID-19 should include reinforcing existing guidance on reducing overprescribing of these drug classes and limiting inappropriate polypharmacy. REGISTRATION: ENCEPP number EUPAS35558.


Subject(s)
COVID-19/diagnosis , COVID-19/epidemiology , Critical Care/trends , Polypharmacy , Psychotropic Drugs/adverse effects , Severity of Illness Index , Aged , Aged, 80 and over , COVID-19/chemically induced , Case-Control Studies , Comorbidity , Dose-Response Relationship, Drug , Drug Prescriptions , Female , Humans , Male , Middle Aged , Psychotropic Drugs/therapeutic use , Scotland/epidemiology
13.
J Ethnopharmacol ; 272: 113952, 2021 May 23.
Article in English | MEDLINE | ID: covidwho-1087047

ABSTRACT

ETHNOPHARMACOLOGICAL RELEVANCE: There are plant species used in the Mexican traditional medicine for the empirical treatment of anxiety and depression. AIM OF THE STUDY: This work assessed the prevalence of self-medication with medicinal plants and the prevalence of the concomitant use of prescribed psychiatric drugs and medicinal plants for treating symptoms associated with anxiety and depression during the Covid-19 lockdown in Mexico. MATERIALS AND METHODS: The suspected adverse reactions associated with drug-herb interactions were assessed. The factors associated with self-medication, the concomitant use of herb-drug combinations, and the presence of adverse reactions due their combined use is also reported. The study was descriptive and cross-sectional using an online questionnaire conducted among population with symptoms associated with anxiety and depression (n = 2100) from seven states of central-western Mexico. RESULTS: The prevalence of the use of herbs (61.9%) and the concomitant use of drug-herb combinations (25.3%) were associated with being diagnosed with mental illness [OR:2.195 (1.655-2.912)] and the use of psychiatric medications [OR:307.994 (178.609-531.107)], respectively. The presence of adverse reactions (n = 104) by the concomitant use of drug-herb combinations was associated with being unemployed [p = 0.004, OR: 3.017 (1.404-6.486)]. CONCLUSION: Health professionals should be aware if their patients concomitantly use medicinal plants and psychiatric drugs. Public health campaigns should promote the possible adverse reactions that might produce the concomitant use of drug-herb combinations for mental illnesses.


Subject(s)
Anxiety/drug therapy , COVID-19/psychology , Depression/drug therapy , Pandemics , Plant Preparations/adverse effects , Plant Preparations/therapeutic use , Adolescent , Adult , Aged , Communicable Disease Control , Cross-Sectional Studies , Drug Interactions , Female , Humans , Male , Mental Disorders/drug therapy , Mental Disorders/psychology , Mexico/epidemiology , Middle Aged , Plants, Medicinal , Prevalence , Psychotropic Drugs/adverse effects , Psychotropic Drugs/therapeutic use , Self Care , Surveys and Questionnaires , Unemployment/psychology , Young Adult
14.
Ann R Coll Surg Engl ; 103(2): 114-119, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1073077

ABSTRACT

INTRODUCTION: Non-injury-related factors have been extensively studied in major trauma and have been shown to have a significant impact on patient outcomes. Mental illness and associated medication use has been proven to have a negative effect on bone health and fracture healing. MATERIALS AND METHODS: We collated data retrospectively from the records of orthopaedic inpatients in a non-COVID and COVID period. We analysed demographic data, referral and admission numbers, orthopaedic injuries, surgery performed and patient comorbidities, including psychiatric history. RESULTS: There were 824 orthopaedic referrals and 358 admissions (six/day) in the non-COVID period, with 38/358 (10.6%) admissions having a psychiatric diagnosis and 30/358 (8.4%) also having a fracture. This was compared with 473 referrals and 195 admissions (three/day) in the COVID period, with 73/195 (37.4%) admissions having a documented psychiatric diagnosis and 47/195 (24.1%) having a fracture. DISCUSSION: There was a reduction in the number of admissions and referrals during the pandemic, but a simultaneous three-fold rise in admissions with a psychiatric diagnosis. The proportion of patients with both a fracture and a psychiatric diagnosis more than doubled and the number of patients presenting due to a traumatic suicide attempt almost tripled. CONCLUSION: While total numbers using the orthopaedic service decreased, the impact of the pandemic and lockdown disproportionately affects those with mental health problems, a group already at higher risk of poorer functional outcomes and non-union. It is imperative that adequate support is in place for patients with vulnerable mental health during these periods, particularly as we look towards a potential 'second wave' of COVID-19.


Subject(s)
COVID-19 , Fractures, Bone/epidemiology , Hospitalization/trends , Mental Disorders/epidemiology , Referral and Consultation/trends , Suicide, Attempted/trends , Adult , Alcoholism/epidemiology , Anxiety Disorders/epidemiology , Comorbidity , Depressive Disorder/epidemiology , Female , Foreign Bodies/epidemiology , Foreign Bodies/surgery , Fractures, Bone/surgery , Humans , Joint Dislocations/epidemiology , Joint Dislocations/surgery , London/epidemiology , Male , Mental Disorders/drug therapy , Orthopedic Procedures , Psychotropic Drugs/therapeutic use , Retrospective Studies , SARS-CoV-2 , Soft Tissue Injuries/epidemiology , Soft Tissue Injuries/surgery , Substance-Related Disorders/epidemiology , Wounds and Injuries/epidemiology , Wounds and Injuries/surgery
15.
Encephale ; 46(3S): S93-S98, 2020 Jun.
Article in French | MEDLINE | ID: covidwho-1065058

ABSTRACT

Although the "panic" word has been abundantly linked to the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic in the press, in the scientific literature very few studies have considered whether the current epidemic could predispose to the onset or the aggravation of panic attacks or panic disorder. Indeed, most studies thus far have focused on the risk of increase and aggravation of other psychiatric disorders as a consequence of the SARS-CoV-2 epidemic, such as obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and generalized anxiety disorder (GAD). Yet, risk of onset or aggravation of panic disorder, especially the subtype with prominent respiratory symptoms, which is characterized by a fear response conditioning to interoceptive sensations (e.g., respiratory), and hypervigilance to these interoceptive signals, could be expected in the current situation. Indeed, respiratory symptoms, such as coughs and dyspnea, are among the most commonly associated with the SARS-CoV-2 (59-82% and 31-55%, respectively), and respiratory symptoms are associated with a poor illness prognosis. Hence given that some etiological and maintenance factors associated with panic disorder - i.e., fear conditioning to abnormal breathing patterns attributable or not to the COVID-19 (coronavirus disease 2019), as well as hypervigilance towards breathing abnormalities - are supposedly more prevalent, one could expect an increased risk of panic disorder onset or aggravation following the COVID-19 epidemic in people who were affected by the virus, but also those who were not. In people with the comorbidity (i.e., panic disorder or panic attacks and the COVID-19), it is particularly important to be aware of the risk of hypokalemia in specific at-risk situations or prescriptions. For instance, in the case of salbutamol prescription, which might be overly used in patients with anxiety disorders and COVID-19, or in patients presenting with diarrhea and vomiting. Hypokalemia is associated with an increased risk of torsade de pointe, thus caution is required when prescribing specific psychotropic drugs, such as the antidepressants citalopram and escitalopram, which are first-line treatments for panic disorder, but also hydroxyzine, aiming at anxiety reduction. The results reviewed here highlight the importance of considering and further investigating the impact of the current pandemic on the diagnosis and treatment of panic disorder (alone or comorbid with the COVID-19).


Subject(s)
Betacoronavirus , Coronavirus Infections/psychology , Pandemics , Panic Disorder/psychology , Pneumonia, Viral/psychology , Anxiety/etiology , Anxiety/psychology , Anxiety Disorders/drug therapy , Anxiety Disorders/epidemiology , Anxiety Disorders/physiopathology , Anxiety Disorders/psychology , COVID-19 , Catastrophization , Comorbidity , Coronavirus Infections/epidemiology , Dyspnea/etiology , Dyspnea/psychology , Female , Humans , Hypokalemia/etiology , Male , Panic Disorder/drug therapy , Panic Disorder/epidemiology , Panic Disorder/physiopathology , Pneumonia, Viral/epidemiology , Psychotropic Drugs/adverse effects , Psychotropic Drugs/therapeutic use , Renin-Angiotensin System/physiology , Respiration/drug effects , SARS-CoV-2 , Stress, Psychological/etiology , Stress, Psychological/physiopathology , Terminology as Topic , Torsades de Pointes/chemically induced , Torsades de Pointes/etiology
16.
Encephale ; 46(3S): S116-S118, 2020 Jun.
Article in French | MEDLINE | ID: covidwho-1065050

ABSTRACT

French recommendations have been proposed for psychotropics use and possible adaptations during the SARS-CoV-2 epidemic. Between uncertainties linked to the lack of data and speculations about possible benefits of psychotropics against the coronavirus, we propose here elements allowing to base the pharmacotherapeutic decisions potentially useful in Covid+ patients with psychiatric disorders.


Subject(s)
Antiviral Agents/therapeutic use , Betacoronavirus , Coronavirus Infections/drug therapy , Drug Repositioning , Pandemics , Pneumonia, Viral/drug therapy , Psychotropic Drugs/therapeutic use , Anti-Anxiety Agents/adverse effects , Anti-Anxiety Agents/therapeutic use , Antiviral Agents/adverse effects , Antiviral Agents/pharmacology , Betacoronavirus/drug effects , COVID-19 , Comorbidity , Coronavirus Infections/epidemiology , Dyspnea/chemically induced , Dyspnea/etiology , Humans , Hypnotics and Sedatives/adverse effects , Hypnotics and Sedatives/therapeutic use , Mental Disorders/drug therapy , Mental Disorders/epidemiology , Pneumonia, Viral/epidemiology , Psychotropic Drugs/adverse effects , Psychotropic Drugs/pharmacology , Respiration/drug effects , Risk Assessment , SARS-CoV-2
17.
Encephale ; 46(3S): S14-S34, 2020 Jun.
Article in French | MEDLINE | ID: covidwho-1065047

ABSTRACT

The 2019-20 coronavirus pandemic (SARS-CoV-2; severe acute respiratory syndrome coronavirus 2) has dramatic consequences on populations in terms of morbidity and mortality and in social terms, the general confinement of almost half of the world's population being a situation unprecedented in history, which is difficult today to measure the impact at the individual and collective levels. More specifically, it affects people with various risk factors, which are more frequent in patients suffering from psychiatric disorders. Psychiatrists need to know: (i) how to identify, the risks associated with the prescription of psychotropic drugs and which can prove to be counterproductive in their association with COVID-19 (coronavirus disease 2019), (ii) how to assess in terms of benefit/risk ratio, the implication of any hasty and brutal modification on psychotropic drugs that can induce confusion for a differential diagnosis with the evolution of COVID-19. We carried out a review of the literature aimed at assessing the specific benefit/risk ratio of psychotropic treatments in patients suffering from COVID-19. Clinically, symptoms suggestive of COVID-19 (fever, cough, dyspnea, digestive signs) can be caused by various psychotropic drugs and require vigilance to avoid false negatives and false positives. In infected patients, psychotropic drugs should be used with caution, especially in the elderly, considering the pulmonary risk. Lithium and Clozapine, which are the reference drugs in bipolar disorder and resistant schizophrenia, warrant specific attention. For these two treatments the possibility of a reduction in the dosage - in case of minimal infectious signs and in a situation, which does not allow rapid control - should ideally be considered taking into account the clinical response (even biological; plasma concentrations) observed in the face of previous dose reductions. Tobacco is well identified for its effects as an inducer of CYP1A2 enzyme. In a COVID+ patient, the consequences of an abrupt cessation of smoking, particularly related with the appearance of respiratory symptoms (cough, dyspnea), must therefore be anticipated for patients receiving psychotropics metabolized by CYP1A2. Plasma concentrations of these drugs are expected to decrease and can be related to an increase risk of relapse. The symptomatic treatments used in COVID-19 have frequent interactions with the most used psychotropics. If there is no curative treatment for infection to SARS-CoV-2, the interactions of the various molecules currently tested with several classes of psychotropic drugs (antidepressants, antipsychotics) are important to consider because of the risk of changes in cardiac conduction. Specific knowledge on COVID-19 remains poor today, but we must recommend rigor in this context in the use of psychotropic drugs, to avoid adding, in patients suffering from psychiatric disorders, potentially vulnerable in the epidemic context, an iatrogenic risk or loss of efficiency.


Subject(s)
Betacoronavirus , Coronavirus Infections , Mental Disorders/drug therapy , Pandemics , Pneumonia, Viral , Psychotropic Drugs/therapeutic use , Age Factors , Antiviral Agents/adverse effects , Antiviral Agents/therapeutic use , Biotransformation , COVID-19 , Cardiovascular Diseases/chemically induced , Comorbidity , Continuity of Patient Care , Coronavirus Infections/drug therapy , Coronavirus Infections/epidemiology , Cytochrome P-450 CYP1A2/metabolism , Drug Interactions , Fever/chemically induced , France/epidemiology , Gastrointestinal Diseases/chemically induced , Humans , Mental Disorders/chemically induced , Mental Disorders/epidemiology , Pharmaceutical Preparations/supply & distribution , Pneumonia, Viral/drug therapy , Pneumonia, Viral/epidemiology , Psychotropic Drugs/administration & dosage , Psychotropic Drugs/adverse effects , Psychotropic Drugs/pharmacokinetics , Respiration Disorders/chemically induced , Risk Assessment , SARS-CoV-2 , Smoking Cessation , Symptom Assessment
18.
Int J Psychiatry Med ; 56(4): 255-265, 2021 07.
Article in English | MEDLINE | ID: covidwho-1058157

ABSTRACT

BACKGROUND: There is still a lot unknown about the novel Coronavirus Disease 19 (COVID-19) and its effects in humans. This pandemic has posed several challenging clinical situations to healthcare providers. OBJECTIVE: We hope to highlight the distinctive challenges that COVID-19 presents in patients with serious mental illness and what steps primary medical teams can take to co-manage these patients with the psychiatry consultants. METHODS: We present a retrospective chart review of four patients who were on psychotropic polypharmacy and admitted to our hospital from the same long-term psychiatric facility with COVID-19 delirium and other associated medical complications. RESULTS: We illustrate how the primary medical teams and psychiatrists collaborated in clinical diagnosis, treatment, and management. CONCLUSIONS: Patients with serious mental illness and COVID-19 infection require active collaboration between primary medical teams and psychiatrists for diagnostic clarification, reduction of psychotropic polypharmacy to avoid adverse effects and drug-drug interactions, prevention of psychiatric decompensation, and active management of agitation while balancing staff and patient safety concerns.


Subject(s)
Bipolar Disorder/complications , COVID-19/complications , COVID-19/psychology , Delirium/complications , Psychotic Disorders/complications , Schizophrenia/complications , Bipolar Disorder/drug therapy , COVID-19/drug therapy , Delirium/drug therapy , Drug Interactions , Female , Humans , Male , Middle Aged , Pandemics , Polypharmacy , Psychotic Disorders/drug therapy , Psychotropic Drugs/therapeutic use , Retrospective Studies , SARS-CoV-2 , Schizophrenia/drug therapy
19.
Transl Psychiatry ; 10(1): 337, 2020 10 02.
Article in English | MEDLINE | ID: covidwho-811592

ABSTRACT

Data are scarce regarding the comorbid mental disorders and their management among COVID-19 patients. This study described the clinical characteristics and management of COVID-19 patients treated in psychiatric inpatient settings due to comorbid first-onset mental disorders in Wuhan, China. This electronic medical records-based study included 25 COVID-19 patients with first-onset mental disorders and 55 patients with first-onset mental disorders without COVID-19 (control group). Data collected included ICD-10 diagnoses of mental disorders, psychiatric and respiratory symptoms, treatments, and outcomes. Adjustment disorder (n = 11, 44.0%) and acute and transient psychotic disorders, with associated acute stress (n = 6, 24.0%) were main clinical diagnoses in the COVID-19 group while serious mental illnesses (i.e., schizophrenia, 24.5%) and alcohol use disorders (10.9%) were overrepresented in the control group. On admission, the most common psychiatric symptom in COVID-19 patients was insomnia symptoms (n = 18, 72.0%), followed by aggressive behaviors (n = 16, 64.0%), delusion (n = 10, 40.0%), and severe anxiety (n = 9, 36.0%). In addition to respiratory treatments, 76.0% COVID-19 patients received antipsychotics, 40.0% sedative-hypnotics, and 24.0% mood stabilizers. At the end of inpatient treatment, 4 (16.0%) COVID-19 patients were transferred to other hospitals to continue respiratory treatment after their psychiatric symptoms were controlled while the remaining 21 (84.0%) all recovered. Compared to the control group, COVID-19 group had significantly shorter length of hospital stay (21.2 vs. 37.4 days, P < 0.001). Adjustment disorder and acute and transient psychotic disorders are the main clinical diagnoses of COVID-19 patients managed in psychiatric inpatient settings. The short-term prognosis of these patients is good after conventional psychotropic treatment.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections , Hospitalization/statistics & numerical data , Mental Disorders , Pandemics , Pneumonia, Viral , Psychotropic Drugs , COVID-19 , China/epidemiology , Comorbidity , Coronavirus Infections/epidemiology , Coronavirus Infections/psychology , Coronavirus Infections/therapy , Electronic Health Records/statistics & numerical data , Female , Humans , Male , Mental Disorders/epidemiology , Mental Disorders/physiopathology , Mental Disorders/psychology , Mental Disorders/therapy , Middle Aged , Patient Care Management/methods , Pneumonia, Viral/epidemiology , Pneumonia, Viral/psychology , Pneumonia, Viral/therapy , Prognosis , Psychiatric Status Rating Scales , Psychotropic Drugs/classification , Psychotropic Drugs/therapeutic use , SARS-CoV-2 , Symptom Assessment/methods , Symptom Assessment/statistics & numerical data
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